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- A popular choice for reconstructing a small to medium sized breast
- The latissimus dorsi is a large, flat muscle in the back which is moved to the site of the breast by swinging it around the rib cage so that it lies at the front of the body
- Very rarely does removing this muscle pose a problem because other back muscles compensate by becoming stronger
- This method may not provide enough tissue to form an entire breast, so an implant and/or expander will also probably be needed and placed behind the muscle to help match the size of the remaining natural breast
- Scars are relatively inconspicuous – often hid under a bra strap
- Latissimus dorsi is a pedicled flap, meaning that the blood vessels supplying the ‘flap’ of muscle and overlying skin remain attached to the body and continue to supply the flap in the same way when it is moved to the new site
- It is mostly muscle that is removed but some skin and fat can also be transferred to the new breast
- This technique is particularly good for immediate reconstruction, as the circle of skin the same size as the mastectomy hole can also be moved, allowing the surgeon to close all wounds without stretching or distorting the remaining natural breast skin
- This technique results in only one circular scar on the breast, round the nipple
- Women who regularly participate in sporting activities such as swimming, tennis or rock climbing, may experience weakness in the back after this procedure
- It is suitable to women who would like a more realistic reconstruction than is possible with an implant alone; women who would like to avoid large abdominal scars and risk reducing abdominal strength; women without enough abdominal fat to create a breast to match the remaining natural breast; women with considerable abdominal surgery or abdominal reduction
Positives:
- Reliable blood supply to reconstructed breast
- Reasonable symmetry and cosmetic result for small to medium volume breasts
- Faster recovery than abdominal-based flaps
- Provides skin to replace the nipple area in immediate reconstruction to allow only a single, circular breast scar around the nipple
- No abdominal weakness after surgery
Negatives:
- Usually only suitable for up to B cup breasts
- Most women will need an implant in addition to the muscle flap
- Skin colour and breast texture is not as natural as abdomen-based reconstruction
- Muscle weakness can affect people who rely heavily on back or shoulder strength (swimmers, rock climbers, golfers, tennis players etc)
The Operation
The operation is carried out in two stages. Firstly, the patient is placed on her side and, while the breast surgeon undertakes the mastectomy at the front, the reconstructive surgeon makes an incision in the back and starts to free the latissimus dorsi muscle from the other tissues of the back. The pedicle (artery and vein to the flap) is identified in the armpit to avoid any inadvertent damage and the muscle with its overlying piece of skin and fat is lifted from the back, tunnelled through the armpit and swung round the ribcage to lie under the breast. The patient is then turned onto her back and the skin of the flap is trimmed to match the hole left by the mastectomy, the breast is compared to the unoperated side and the muscle is sutured to create the contour of the breast mould. If necessary, an implant is inserted. Drains are inserted in both the breast and the back wounds which are then closed, generally with dissolving stitches.